Miller's Spine Flashcards
axis of rotation of compression fx
middle column
MOA for Burst fx
axial
Axis or rotation for flexion and distraction
anterior longitudinal ligament
burst fc in pt that is neuro intact with minimal deformity
- board brace answer?
can be treated in extension bracing
Burst
- ant vs post?
Ant- neuro deficit with retropulsion
post - multiseg fication, lamina fx
bony chance
ligamentous chance
Treatment for each
extension bracing
posterior tension band
% of those with asymptomatic disc herniation on MRI
25-37%
movement causing disc pain
movement causing facet pain
disc-> flexion
facet-> extension
most sensitive method for detecting isthmic spondy
SPECT
nerve that innervates facet joint
medial branch of dorsal primary rami and sinuvertebral n
most common nerve affected with L5/S1 isthimic spondy
- whats it from
exiting L5 nerve root
- due to a fibrocartilaginous reparative process under the pars
causes of iatragenic isthimic spondy
burr through the pars
removal of 100% of one facet
removal of 50% of bilateral facet
treatment for lateral recess stenosis
- causes unilateral nerve root pain
medial facetectomy
- preserve the pars
Surgical treatment for thoracic HNP
costotransversectomy
transthoracic approach
isolated laminectomy NOT the answer
main cause of epidural abscess
clinical presentation compared to diskitis
operative cause
ESI
Lumbar puncture
more systemically ill
contents of carotid sheath
internal and common carotid a
internal jugular vein
vagus n
finding on laryngoscope that suggest vocal cord is paralysized
Adducted -> abnormal
abducted they are normal
Difference in injury to superior vs recurrent laryngeal n
superior
- upper cervical serugery
- high note phonation NOT vocal cord paralysis
recurrent causes vocal cord paralysis
Benefit of TLSO over Jewett brace for thoracolumbar spin fx’s
TLSO gives more rotational control
% of people with resolution of acute low back pain by 1 mos
90%
Most important predictor of successful outcome after diskectomy for lumbar HNP
+ straight leg raise
low Japanese score
higher level of dysfunction from cervical myelopathy
finding on MRI C spine indicative of permanent change to spinal cord
myelomalacia -> cord enhancement
limit of anterior surgery for myelopathy that indicates addition of posterior procedure
2 level corpectomy
3 or more levels that need addressed
location of screws for cervical fusion
C1- lateral mass
C2- pedicle
C3-6 - lateral mass
C7 and down- pedicle
orientation of lateral mass screws in C spine
up and out
- out avoids vertebral a
- up avoids exiting nerve root
Cervical level when screws are oriented outward
C7
Unique to each
- anterior cervical
- posterior cervical
anterior - dysphagia
posterior - infection
otherwise they have similar rates of other complications
- C5 palsy, progressive myelopathy, durotomy
CA to play contact sport
- findings related to cervical stenosis
myelomalacia
CSF effacement
Indication for surgery for RA cervical C1/2 instability
ADI > 10mm
PADI < 14mm
progressive deficits
Indication for surgery for RA basilar invagination
progressive cranial migration
occiput to cervical fusion
% who improve from nonop of cervical radiculopathy
75%
Operative indication for cervical radiculopathy
NOT weakness -> this always improves
persistent and disabling pain for 6-12 wks after failed nonop
interval of ACDF
SCM lateral medial is strap muscles
Risk of adjacent segment disease after C spine fusion
1.5-4%
Neural crest ->
Neural tube ->
notocord ->
PNS, sympathetic trunk
spinal cord
vertebral bodies and disc
Positive signal in MEP/SEP
MEP
- sustained > 75% decrease in MEP amp
SEP
- 50% decrease in am
- 10% increase in latency
Radiograph to clear C spine
Either
- XR: AP/lat and open mouth odontoid, gotta image top of T1
- CT to bottom of 1st thoracic T1 vertebra
how to tell difference btw spinal shock and neurogenic shock
both with bradycardia and hypotension
- neurogenic shock has intact bulbocavernosus reflex
indication for high dose steroid in SCI
NO LONGER INDICATED
- complications outweigh potential benefits
appropriate timing of surgery for spine injury in setting of SCI
incomplete w/in 12 hours
complete w/in 24 hours
When to operate on central cord
severe compression
worsening exam with mild stenosis
pre-exhisting myelopathy
HLA-B8
DISH
Treatment for cervical diskitis/epidural abcess
emergent decompression/stabilization
os odontoideum is a CA to…
contact sports
When to operate on type 2 odontoid
< 50 yo
> 50yo
< 50 —> risk factors of nonunion
> 50 –> already met criteria b’c they’re older than 50 making at risk for nonunion
combined lateral mass overhang C1 on C2 that meets criteria of instability
> 7mm
>8.1mm with magnification
difference on lateral C spine xray to help determine diff btw unilateral vs bilateral jumped facet
unilateral vert body is 25% subluxed
bilateral will be 50% translated
when to do urgent closed reduction for jumped facet of c spine
bilateral and alert is only scenario
if unilateral they get MRI first
- reason is bilateral has the high risk of spinal cord injury so you want to do it ASAP
- unilateral no rush, get MRI, then OR
